Background: Gait modifications can reduce the knee adduction moment, a representation of knee loading. Reduced loading may help to slow progression of medial knee osteoarthritis. We aimed to investigate the response of patients with medial knee osteoarthritis to direct feedback on the knee adduction moment as a method for modifying the gait pattern, before and after training with specific gait modifications. Methods: Forty patients with medial knee osteoarthritis underwent 3D gait analysis on an instrumented-treadmill, while receiving real-time feedback on the peak knee adduction moment. Patients were trained with three different modifications; toe-in, wider steps and medial thrust gait. The response to real-time feedback on the knee adduction moment was measured before and after training. To evaluate the short term retention effect, we measured the changes without feedback. We also evaluated the effects on the knee flexion moment and at the hip and ankle joints. Findings: With direct feedback on the knee adduction moment, patients were initially unable to reduce the knee adduction moment. After training with specific modifications, peak knee adduction moment was reduced by 14% in response to direct feedback. Without feedback a 9% reduction in peak knee adduction moment was maintained. Hip moments were not increased with modified gait, but small increases in ankle adduction moment and knee flexion moment were observed. Interpretation: Real-time biofeedback directly on the knee adduction moment is a promising option for encouraging gait modifications to reduce knee loading, however only when combined with specific instructions on how to modify the gait.@en

Background: Walking speed is a confounding factor in biomechanical analyses of gait, but still many studies compare gait biomechanics at comfortable walking speed (CWS) that is likely to differ between groups or conditions. To identify gait deviation unrelated to walking speed, methods are needed to correct biomechanical data over the gait cycle for walking speed. Research question: How to compare knee kinetics over the gait cycle at different walking speeds? Methods: 22 asymptomatic subjects walked on a dual-belt treadmill at CWS and 4 fixed speeds. Knee moments in sagittal (KFM) and frontal plane (KAM) were calculated via inverse dynamics. The net moment differences between CWS and fixed speed were expressed as a root-mean-square error (RMSE) normalized to the range of the variable. Two methods to correct for walking speed were compared. In method 1, KFM and KAM values were estimated based on interpolation between speeds at each percentage of the gait cycle. In method 2, principal component analysis was used to extract speed related features to reconstruct KFM and KAM at the speed of interest. The accuracy of both methods was tested using a leave-one-out cross validation. Results: Walking speed influenced the magnitude and shape of KFM and KAM. To account for these speed influences using both methods, leave-one-out cross validation showed low normalized RMSE (< 5 %), with little difference between the two methods. RMSE for both reconstruction methods were up to 60 % lower than the RMSE between CWS and fixed speed. Significance: Both methods could accurately correct knee kinetics over the gait cycle for the effects of walking speed. Walking speed dependency should be incorporated in each gait laboratory's reference dataset to be able to identify gait deviations unrelated to gait speed.@en